Daylight Saving Time stumps hospital record-keeping

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Forest Markowitz, the longtime assistant of Marvin Schneider, New York City’s official clock master, adjusts the bar to turn the arrows of the clock atop the Bell Ringers’ Monument in Herald Square, Oct. 31, 2018. Daylight saving time ended at 2 a.m. Sunday, Nov. 4, and it fell to Schneider to reset some of the grandest public clocks in the city. (Chang W. Lee/The New York Times) - Bulletin

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Forest Markowitz, the longtime assistant of Marvin Schneider, New York City’s official clock master, adjusts the bar to turn the arrows of the clock atop the Bell Ringers’ Monument in Herald Square, Oct. 31, 2018. Daylight saving time ended at 2 a.m. Sunday, Nov. 4, and it fell to Schneider to reset some of the grandest public clocks in the city. (Chang W. Lee/The New York Times)7985971

One of the most popular electronic health records software systems used by hospitals, Epic Systems, can delete records or require cumbersome workarounds when clocks are set back for an hour, prompting many hospitals to use paper records for part of the night shift.

“It’s mind-boggling,” said Dr. Mark Friedberg, a senior physician policy researcher at RAND. In 2018, “we expect electronics to handle something as simple as a time change. “Nobody is surprised by Daylight Saving Time. They have years to prep. Only, surprise, it hasn’t been fixed.”

Dr. Steven Stack, a past president of the American Medical Association, called the glitches “perplexing” and “unacceptable,” considering that hospitals spend millions of dollars on the systems, and Apple and Google seem to have dealt with seasonal time changes long ago.

Carol Hawthorne-Johnson, an intensive care nurse in California, said her hospital doesn’t shut down the Epic system during the fall time change. But she’s come to expect that the vitals she enters into the system from 1 a.m. to 2 a.m. will be deleted when the clock falls back to 1 a.m. One hour’s worth of record-keeping “is gone,” she said.

Hospital staff members have learned to deal with it by taking extra chart notes by hand, but it’s still a burden, she said, especially if vitals change, or a patient needs something like a blood transfusion.

Although hospitals often avoid the software glitches by turning the software off and switching to paper charts, it’s far from ideal because hospitals have become increasingly reliant on electronic systems, said Stack, an emergency physician in Kentucky.

“When electronic medical records work, it’s wonderful,” he said, but when the system is turned off, doctors can’t use it to access patient records or order tests. Whiteboards are a thing of the past, and some staff members aren’t as comfortable with paper records because they’ve relied on electronic records their entire careers.

The one-hour pause slows everything down, which can cause patients to spend more time in emergency department waiting rooms, prompting some to go home before seeing a health care provider. That’s dangerous, Stack said.

Not all hospitals turn Epic off, however. At Johns Hopkins Hospital, providers who need to check patients periodically through the night use a workaround. They enter vitals at 1 a.m. and then when the clock falls back an hour later and they have to enter new vitals, they list them at 1:01 a.m. They leave a note that it’s an hour later, not a minute later.

Other electronic medical records systems may require similar workarounds, said Jennifer Carpenter, vice president of IT clinical systems at University Hospitals in Cleveland, which uses several electronic medical records systems. Cerner, another major medical records company, was unavailable for comment, but many hospitals plan for Cerner to be down during the time change, too.

When asked to comment on the glitches and workarounds, Epic spokeswoman Meghan Roh said in a statement:

“Daylight (Saving) Time is inherently nuanced for health care organizations, which is why we work closely with customers to provide guidance on how to most effectively use their system to care for their patients during this time period. We’re constantly making improvements and looking for opportunities to enhance the system.”

But Friedberg pointed out hospitals are locked into their electronic medical record systems because they’ve invested so much money in them. And it would cost even more to convert and transfer records into a new system. As a result, there’s little incentive for companies to improve their products, he said.